DME Extended-Interval Anti-VEGF: Improving Adherence and Choosing the Right Agent

In "DME Extended-Interval Anti-VEGF: Improving Adherence and Choosing the Right Agent," the panel explores how longer dosing intervals change patient engagement and agent selection.

Dr. Yannuzzi notes that newer agents are built for durability as much as efficacy and asks how extending the interval has changed barriers to treatment and outcomes. Dr. Patel calls it a major benefit, starting with the conversation itself. Simply telling a patient that longer intervals are possible gives them optimism.

He explains that patients seen every 4 to 8 weeks develop fatigue. Early gains after the first three injections bring excitement. After two or three years with little change, patients start asking what the practice has done for them lately. The prospect of extending treatment renewed their interest in coming in and trying something different.

Dr. Patel says spacing visits improves compliance, especially when care is holistic. Many patients are also taking GLP-1 therapies, so a clinician can tell them their A1C is down and a new agent may let them go two or three extra weeks. He adds that the VISTA and VIVID extension study showed treatment burden falling over time, which supports telling patients that this is not forever.

Dr. Yannuzzi then asks how Dr. Patel chooses among anti-VEGF agents. Dr. Patel puts safety first, noting that these agents have a strong track record with low complication rates. If safety is roughly equal, he looks to efficacy.

In his practice, earlier and faster drying in DME helps long-term vision. He cites Protocol V, where patients with mild edema did not lose vision in the short term. After more than six years in practice, however, he has seen some of those patients lose vision, and anti-VEGF can improve macular ischemia.

He favors the most efficacious agent from the start, since a strong early response keeps patients coming back. Dr. Yannuzzi agrees that the first couple of injections are key.

The next episode, "DME Extended Dosing Trial Results: Injection Reduction With High-Dose Anti-VEGF," features Dr. Yannuzzi presenting the PHOTON trial and the design of its cost analysis.